HEALTH INFORMATION

Discusses test used to check your heart and coronary arteries. Covers reasons cardiac catheterization is done. Looks at how to prepare. Explains how the test is done in the cardiac catheterization laboratory (cath lab) by a cardiologist. Covers risks.

Discusses test used to check your heart and coronary arteries. Covers reasons cardiac catheterization is done. Looks at how to prepare. Explains how the test is done in the cardiac catheterization laboratory (cath lab) by a cardiologist. Covers risks.

Cardiac Catheterization

Test Overview

Cardiac
catheterization is a test
to check your heart. This test uses a thin flexible tube called a catheter that is inserted into the heart through blood vessels. This test can include a coronary angiogram, which checks the coronary arteries.

A cardiac catheterization can check blood flow in
the coronary arteries, check blood flow and blood pressure in
the chambers of the heart, find out how well the heart
valves work, and check for defects in the way the wall of the heart moves. In
children, this test is used to check for heart problems that have been present
since birth (congenital heart defect).

A coronary angiogram is used to find out if you have disease in your coronary
arteries (atherosclerosis). If you have atherosclerosis, this
test can pinpoint the size and location of fat and calcium deposits (plaque) that are narrowing your coronary arteries.

Percutaneous coronary intervention (PCI) is similar to coronary angiogram, but it is used to open up a narrowed coronary artery with special tools. PCI includes:

Why It Is Done

Cardiac catheterization

Find out if a congenital heart defect is present and how
severe it is. Cardiac catheterization sometimes can also be used to help
correct the defect.

Check blood flow through the heart after
surgery.

Find out how well the heart valves work.

Coronary angiogram

A coronary angiogram is done to:

Check blood flow in the coronary arteries
and, if you have
coronary artery disease, determine whether
surgery or another type of procedure, such as angioplasty with stenting, is
needed.

How To Prepare

Tell your doctor if you:

Are having an angiogram and are allergic to the iodine dye used in the
contrast material or any other substance that contains
iodine.

Are allergic to any substances that might be used during the procedure, such as latex or talc.

Are allergic to any medicines.

Take any medicines, vitamins, supplements, or herbal remedies. Some of these can increase your risk of bleeding. Some medicines can cause other problems during the test. Your doctor will tell you which medicines to stop before your test and which medicines you can take safely. Medicines to mention include:

Blood-thinning medicine, such as warfarin, clopidogrel (Plavix), or aspirin.

Have
asthma or have ever had a serious allergic reaction
(anaphylaxis) from any substance, such as the venom
from a bee sting.

Have any bleeding problems.

Have
kidney disease. The contrast material used during
an angiogram can cause kidney damage in people who have poor kidney
function. If you have a history of kidney problems, blood tests (creatinine,
blood urea nitrogen) may be done before and after the test to
confirm that your kidneys are functioning properly.

Talk to your doctor about any concerns you have regarding
the need for the test, its risks, how it will be done, or what the results will
mean. To help you understand the importance of this test, fill out the
medical test information form(What is a PDF document?).

Arrange for someone to take you home
after the test. You may not have to stay in the hospital overnight.

Do not eat or drink (except for a small amount of water) for 6 to 12
hours before the test.

Take your medicines as directed by your doctor. You might stop taking certain medicines before your test and start taking them again after your test.

Before the test,
remove any necklaces, bracelets, rings, or other jewelry. You should also
remove nail polish from your fingernails and toenails.

Be sure to
empty your bladder completely just before the test.

How It Is Done

Before the test

You will be asked to lie on a flat
table under a large X-ray machine. Several small pads or patches (electrodes) will
be attached to your legs and arms. These leads are
connected to an
electrocardiogram (EKG, ECG) machine that continuously
records the electrical activity of your heart during the test.

A
device called a
pulse oximeter that measures oxygen levels in your
blood and monitors your pulse may be clipped to your finger.

An
intravenous (IV) needle will be inserted into a vein in one of your
arms to give you fluids or medicine during the procedure. Through the IV line you will receive a
medicine to help you relax (sedative). You may
be awake during the procedure. But even if you are awake, the sedative may make
you so sleepy that you may not remember much about the procedure.

During the test

The catheter insertion
area will be shaved and cleansed with an antiseptic solution before the test.
Sterile towels will be draped over you, except for the area over
the catheter insertion site. There are a few options for where the catheter is inserted. If you are having a cardiac catheterization to check the right side of your heart, the catheter is inserted into a vein in your neck or groin. If the test will check the left side of your heart or your coronary arteries, the catheter is inserted into an artery in your groin or arm.

A
local anesthetic will be injected into the skin at the
insertion site. A blood vessel is punctured by a special needle or exposed by
making a small cut in the skin so that the catheter can be passed into the
blood vessel. The catheter is slowly advanced through the blood vessel into
your body. The catheter tip is moved into various positions in the heart's
vessels and chambers while the doctor watches its progress on the imaging
screen. Pressures within the heart chambers can be measured. Blood and heart
tissue samples may also be removed through the catheter, if necessary.

You may be asked to hold your breath
or move your head slightly to provide clear views of the heart and its blood
vessels.

During an angiogram, a small amount of dye (contrast material) will be
injected through the catheter into your coronary
arteries. Pictures show the arteries as the dye moves through them. You may be
asked to cough to help clear the contrast material out of your heart. Or you may be asked to take a deep breath and hold it.

It is important to lie as still as
possible, since motion can make the images blurry or hard to interpret. A
health professional will help you stay comfortable and will help you resist the
urge to move around. Be careful not to touch the sheets or the area where the catheter is inserted because you may contaminate the sterile areas and increase the risk of
infection.

You
may be given nitroglycerin to help open up your coronary arteries. Or you may
be given an injection of a medicine that causes the coronary arteries to
narrow.
You may be asked to breathe into a special mouthpiece
to help measure the flow of oxygen in your circulating blood.

The test takes about 30 minutes. But you need time to get ready for it and time to recover. It can take up to 6 hours total. The
length of the test is not an indication of the seriousness of your condition.

After the test

The catheter will be removed from
the insertion site. To prevent bleeding, the site may need to be closed using
pressure, stitches, or a special seal. For example, if the catheter was
inserted in your wrist or groin, firm pressure will be applied to the area for
about 10 minutes to stop the bleeding. Then a pressure dressing will be placed
over the area. If the catheter was inserted in your elbow, a few stitches will
be used to close the wound.

After the test, you will be taken to an observation room, and a health
professional will periodically monitor your heart rate, blood pressure, and
temperature and check for signs of bleeding at the insertion site. The pulse,
color, and temperature of the arm or leg in which the catheter was inserted
will also be checked periodically. You may be given medicine to relieve pain.

If the catheter was inserted in
your groin, you may have to lie in bed with your leg extended for several hours
(such as 1 to 4 hours), depending on the exact procedure used and your medical
condition. After that, you can move about freely.

If the catheter was inserted in your arm, you may be able to sit up and get out of bed right away. But you will need to keep your arm still for at least 1 hour.

A child who has had cardiac
catheterization may need to be held by a parent for several hours after the
test to prevent the child from moving his or her leg.

You should
drink plenty of liquids for several hours after the test. This will prevent
dehydration and help flush the contrast material out
of your body.

Depending on the results of the test, you may be
sent home either after a short observation period (such as 6 hours) or on the
next day. If any stitches were placed in your arm, they may be removed in 5 to
7 days. Do not do strenuous exercise and do not lift anything heavy until your doctor says it is okay. This may be for a day or two.

If you are breast-feeding and had an angiogram in which dye was injected into your body, do not breast-feed your baby for 2 days after this test. During this time, you can give your baby breast milk you stored before the test, or you can give formula. Discard the breast milk you pump for 2 days after the test.

How It Feels

You will feel a sharp sting when the
local anesthetic is injected to numb your skin over the catheter insertion
site. When the catheter is inserted, you may feel a brief, sharp pain. The
movement of the catheter through your blood vessel may cause a feeling of
pressure, but it is not usually considered painful. People commonly experience
skipped heartbeats for a few seconds when the catheter touches the walls of the
heart.

If a dye (contrast material) is injected, you may feel warm
and flushed and have a metallic taste in your mouth. Some people feel sick to
their stomach or have a headache. You also may feel nauseous or lightheaded,
have chest pain or pressure, irregular heartbeats, an urge to cough, mild itching, or
hives from the contrast material. If you have any of
these symptoms, tell your doctor how you are feeling.

The
temperature in the catheterization lab is kept cool so that the equipment does
not overheat. For many people, the hardest part of the test is having
to lie still for an hour or more on the hard table. You may feel some stiffness
or cramping.

After you go home

You may experience some soreness and bruising at the
insertion site. This is temporary and should disappear within 2 weeks. It is
normal for the site to feel tender for about a week. Call your doctor
immediately if:

Your arm or leg becomes pale, cold, painful, or
numb.

You have a fast-growing, painful lump at the catheter insertion site.

Redness, swelling, or discharge from the catheter insertion
site develops.

You have a fever.

Risks

Complications related to the catheter include:

Pain, swelling, and tenderness at the catheter
insertion site.

Irritation of the vein by the catheter (superficial
thrombophlebitis). This can usually be treated with warm
compresses.

Bleeding at the catheter site.

A bruise
where the catheter was inserted. This usually goes away in a few
days.

Trouble urinating after the procedure.

Serious complications are
rare, but they can be life-threatening. Serious complications are more likely
to occur in people who are critically ill or elderly. These complications may
include:

Sudden closure of the coronary artery.

Small
tear in the inner lining of the artery.

Allergic reaction to the contrast material, with hives
and itching and, in rare cases, shortness of breath, fever, and
shock. These allergic reactions can usually be
controlled with medicines.

Kidney damage. In rare cases, the
contrast material can damage the kidneys, possibly causing kidney failure. People with diabetes and kidney
disease are at greatest risk for kidney damage.

Heart attack or stroke.

The need for more procedures or surgery to take care of complications.

Radiation risk. There is always a slight risk of damage to cells or tissues
from being exposed to any radiation, including the low levels of X-ray used for
this test. But the risk of damage from the X-rays is, in most cases, very low
compared with the potential benefits of the test.

Many conditions can affect the results of a cardiac
catheterization. Your doctor will discuss any significant abnormal results with
you in relation to your symptoms and past health.

What Affects the Test

Reasons you may not be able to
have the test or why the results may not be helpful include:

Extreme anxiety that causes high blood pressure and irregular
heartbeats.

Kidney or liver failure.

Inability to
follow directions during the procedure.

What To Think About

This test usually is not done on people who have had
severe
allergic reactions to contrast material, poorly
controlled
heart failure, life-threatening heart rhythm problems,
or advanced
kidney disease.

Cardiac catheterization
is not usually done during pregnancy because the radiation could damage the
developing
fetus. But in a life-threatening emergency, this
procedure may be necessary to help save a pregnant woman's life. In such cases,
the fetus is protected as much as possible from radiation exposure with a lead
apron.

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